Things to note:- Nil per mouth.
- Nasogastric suction when persistent vomiting or ileus occurs.
- Parenteral fluid replacement to correct metabolic and electrolyte disturbances.
- Parenteral nutrition support may be necessary.
- Drainage of abscess, psuedocyst, if required.
Medical Treatment:For pain:
- Morphine, slow IV, 10-15 mg 4-6 hourly as required.
Acute symptomatic hypocalcaemia- Calcium gluconate 10%, IV infusion, 10 mL as a bolus over 10 minutes.
- Follow with 60-120 mL diluted in 1 L sodium chloride 0.9%, administered over 12-24 hours.
- Monitor serum calcium at least 12 hourly.
If serum magnesium less than 0.5 mmol/L:
ADD - Magnesium sulphate, IV infusion, 25-50 mmol in 12-24 hours.
- 1 mL magnesium sulphate 50% equal to 2 mmol magnesium.
Antimicrobial therapy The administration of prophylcatic antibiotics to patients with severe necrotising pancreatitis prior to the diagnosis of infection is not recommended. For abscess of the pancreas, etc: Broad spectrum IV antibiotics, e.g:
- Ampicillin, IV, 1 g 6 hourly.
PLUS - Gentamicin, IV, 6 mg/kg once daily.
PLUS- Metronidazole, IV , 500 mg 8 hourly.
When to refer: - All patients with moderate or severe pancreatitis.